A Pharmacy Leader’s Perspective on Recent CIDRAP Recommendations

A Pharmacy Leader’s Perspective on Recent CIDRAP Recommendations

Over the past few weeks I have had the opportunity to review and consider many of the points outlined in the recent Center for Infectious Disease Research and Policy (CIDRAP) publication titled, Ensuring a Resilient US Prescription Drug Supply and am deeply appreciative of the thoroughness and thoughtfulness this team approached the topic. Trying to make sense of drug shortages is no simple task but the CIDRAP team did an excellent job and their work will certainly be invaluable to many of the professionals outside of healthcare that are striving to better understand this pernicious and persistent issue. I would like to emphasize a few additional points for discussion, which build on the article’s key theme of transparency.

A Focus on Transparency

It’s impossible to overstate how the current lack of transparency contributes to, not only many of the circumstances that spawn shortages, but also to the exacerbation of shortages that might have been potentially more manageable, or even prevented, in some cases. However, transparency isn’t as straightforward of a goal as it seems at first which is quickly revealed once you start asking the hard question: “exactly what information will be transparent to whom?” The answer is guaranteed to be different depending on who is asking or answering. The general objective of improving transparency is fairly well agreed upon across stakeholders but the exact objective of how that transparency will be defined or even who gets to decide if it is sufficiently transparent remains uncertain. As we flesh out ideas and innovations, like those mentioned in the CIDRAP article, there are some very important considerations to be made if any proposed interventions are going to be successful.

If the federal government is to create a unique entity to research, monitor, and improve the drug supply chain along the lines of what CIDRAP has suggested, these are some important considerations for that effort:

This new entity absolutely must incorporate representation of ALL stakeholders across the entire drug supply chain.
Physicians, providers, pharmacists, nurses, hospitals, and yes, even the public (our patients) need to be allowed to contribute, participate, and have influence in this effort. Too often, this issue gets characterized as purely a supply chain issue without full appreciation of the public health and human consequences in the decisions being made.

There needs to be a unified vision for what success looks like and how it will be objectively measured and quantified as well as what data will be essential for that analysis.
It’s the unfortunate reality that most of the data needed to provide the type of insight and transparency required is held tightly within a number of corporate interests, many of which are direct competitors. As another current public health crisis of opioid addiction has demonstrated, not all stakeholders can be trusted to prioritize public health over economic interests. Reconciling the conflict between the financial interests of supply chain stakeholders and our public health interests may very well prove to be the greatest challenge to overcome. If we’re not able to agree on the metrics of success, the data required to perform that analysis with integrity, will run the risk of limiting its impact from the outset. This is usually where someone offers “blockchain” as the miracle solution—I think it will likely be a part of a solution, but there are many other hurdles to overcome even with blockchain.

Upstream supply chain transparency is greatly needed, but we have significant issues with downstream supply chain transparency that need just as much attention.
The CIDRAP report focused most of its attention on the needs and issues of the upstream supply chain with limited time spent on the issues of poor transparency in the downstream supply chain. It is in this maddeningly opaque downstream supply chain world that drug shortage response teams are doing the, at times, impossibly difficult work of making sure patient care isn’t compromised. This is the end of the supply chain where the human cost is realized in both the harm incurred by the public, as well as the pharmacists and health professionals who agonize over mitigating that harm. The causes and impacts of an inadequately transparent downstream supply chain deserve to be explored in greater detail.

Information and Data Still Require Connectivity and Responsiveness for Full Collaboration

Transparency into where drug inventory is, who’s using it, how much is needed, who may be hoarding supply, and how inventory should best be equitably diverted is only part of the solution. Even with all that information and data, we lack the overall connectivity and responsiveness as a national healthcare system to collaborate so patients don’t suffer from our failures. We need to fully acknowledge that, until we start approaching our drug supply chain as a truly interconnected and interdependent system, we will not solve the issue of transparency. I still haven’t decided if the solution proposed of a unique federal entity devoted to many of these issues is the solution, but if we’re going to ever have a chance of making substantive improvements to our nation’s drug supply chain we are going to need transparency and a more aligned mindset through a common commitment to work together across the supply chain.

About the Author:

Nate Peaty PharmD, MS

As a health-system pharmacy leader, Nate has been responsible for advancing complex, inpatient pharmacy operations and support systems through innovation. His commitment to furthering the role of automation in hospital operations and passion for designing better solutions for healthcare professionals led him to co-found OrbitalRX where, as its Chief Product Officer, he currently is responsible for corporate and product strategy, research, innovation partnerships, and customer relationships. In his role at OrbitalRX, Nate is designing a new generation of pharmacy automation solutions that challenge assumptions and power a more sustainable infrastructure for health-system and  drug supply chains.

Juniper Alcorn, PhD

8 Ways Technology is Improving Hospital Drug Shortage Management During COVID-19

8 Ways Technology is Improving Hospital Drug Shortage Management During COVID-19

Hospitals are under significant pressure. More resources are going toward caring for COVID-19 and other emergent cases while revenue is suffering with the postponement and cancellation of elective procedures. Budgets are strained, forcing hospitals to lay off staff or delay the hiring of new employees even as staff workload increases. Unfortunately, relief isn’t likely to come soon. As states are reopening, most are experiencing surges in positive cases and hospitalizations. A second wave of the novel coronavirus is still anticipated for the fall, right around when flu season will begin picking up steam. It’s potentially a perfect storm that would place further strain on our embattled health-systems. This means hospital pharmacies need to work on improving their drug shortage management strategy.

There are many steps hospitals will need to take if they hope to effectively weather this prolonged period of turmoil and disruption. Perhaps one of the most significant is performing an assessment of those processes considered to be the “status quo” and determining whether complacency is getting in the way of achieving operational improvements. Now is the time to make significant changes that advance healthcare rather than continuing to rely on approaches that are antiquated and inefficient. As Mayo Clinic Chief Executive Officer Gianrico Farrugia, MD, wrote in Fortune, “The pandemic’s disruptive force has spurred transformational change in our organization, as well as in many others. We must actively resist a return to the old way of doing things, maintain the improvements we’ve made, and continue to invest in research and strategic collaborations that will produce a health care system that serves everyone better.”

This mentality should extend to how hospital pharmacies approach their drug shortage management. This is the time to embrace technology as a way to eliminate manual processes, better organize systems, and drive efficiencies. There’s never been a greater need for technology-enabled healthcare to help us better respond to the challenges of today and prepare for what’s looming tomorrow. Drug shortage management efforts have to be faster, smarter, and more efficient to ensure that delivery of care during these demanding times isn’t compromised. Here are 8 ways technology can help hospitals improve their drug shortage management:

Reap the Benefits of Automation

For many hospitals, their entire drug shortage management process is manual. From data collection and analysis to searching for product availability, pharmacy employees spend hours upon hours completing these and other tasks. How would you benefit by eliminating manual processes and then changing your workflow from being reactive to becoming proactive? How would that impact operations and employee satisfaction? The right technology can help you begin to automate drug shortage management workflows. The trickledown benefits will be significant.

Reposition Valuable Resources

The more you rely on your technology to automate once-manual processes and improve staff efficiency with completing remaining manual processes, the less staff you will need to assign to drug shortage management tasks. At a time when staffing is strained, as previously noted, this can be a game-changer. Depending upon your staffing situation, you may be able to reassign team members to other critical pharmacy tasks, return to a more typical schedule that scales pharmacy staffing back closer to pre-pandemic levels, and reduce reliance on overtime. Even before the pandemic, drug shortages were costing U.S. hospitals at least $359 million a year on labor costs, according to a Vizient study.

Improve Efficiency

Improving drug shortage management with technology can greatly increase efficiency and productivity. Eliminated are laborious, time-consuming processes of manual data entry into spreadsheets, records research, and compilation of information, to name a few. Staff can gain instant visibility into medications on hand, locations of medications, speed of usage, trending, and more. The results: tasks are completed faster, decisions are made with greater confidence thanks to supporting data, data entry and compilation errors are greatly reduced, and more opportunities for improvements are identified. Furthermore, an investment in technology that fuels efficiency can enhance staff satisfaction since employees will feel like their time and skills (beyond manual data entry and retrieval) are valued. More satisfied and engaged staff are proven to be more productive and less likely to experience burnout.

Save Money

If you needed to invest in more staff and/or overtime to account for the increased workload associated with responding to COVID-19 demands, drug shortage management technology can help you bring these staffing levels and their expenses under control. Technology can also help you make more proactive medication purchasing decisions, permitting you to maximize savings associated with bulk purchasing, competitive shopping and pricing, avoiding reliance on expensive rushed shipping, and other intelligent buying strategies. Once you invest in the technology, the savings associated with leaner staffing and smarter purchasing accumulates and should quickly cover the cost of the solution.

Situational Awareness

Drug shortage management technology can inform you of potential shortages looming on the horizon, both internal and external. When staff are alerted to decreasing levels of medications in stock, including those involved in caring for COVID-19 patients, they can act to replenish stock and/or begin to execute a response plan to ration medications or pursue alternatives. When staff learn of potential disruptions in the supply of medications, they can take similar actions as well as further engage in discussions with wholesalers and distributors about trends and potential solutions.

Make Decisions Faster

As the American Society of Health-System Pharmacists notes, hospitals were experiencing shortages of key injectable drugs prior to the pandemic. Now, unprecedented demand due to the large numbers of critically ill patients with the novel coronavirus is serving to further worsen shortages in medications such as sedative, analgesics, and paralytics. As surges bring more patients to hospitals, pharmacy staff may find themselves under the gun to make a wide range of decisions in areas including drug allocation, purchasing and rationing. A drug shortage management system can provide the information needed to help staff make faster, data-driven, and educated decisions more likely to achieve their desired results.

Enhance Communication and Mitigation Strategies

Drug shortage technology that includes components focused on supporting communication (e.g., a centralized communications center) can better ensure key stakeholders throughout the health system are current on existing and potentially future challenges. With such knowledge comes improvements in the coordination of effective use and conservation of drugs in short supply. In addition, technology can provide reports to stakeholders on action follow-through and progress made concerning preservation and synchronization efforts.

Sourcing and Procurement Support

Diversity in one’s supply base (i.e., multi-vendor sourcing) is beneficial as it provides a hospital with more options to purchase the medications needed and at more competitive prices. This is proving especially helpful during this time when there is so much disruption to the supply chain and significant developments leading to rapid swings in number of cases and case types. However, communicating and coordinating with and purchasing from multiple vendors is one of the more time-consuming and inefficient tasks pharmacy staff are expected to complete. Drug shortage technology with a procurement center feature can eliminate the need for engaging with multiple vendors by providing a consolidated view of options that streamlines educated decision-making on purchasing.

Adding Drug Shortage Management Technology

If it sounds like your hospital would benefit from drug shortage management technology, consider scheduling a demo of OrbitalRX. It is the only data-unifying platform that proactively manages drug shortages through predictive analysis and real-time situational awareness in a pharmacy-focused workflow. OrbitalRX is a solution that will help you better navigate your hospital through the clinical, operational, and business impacts of the COVID-19 outbreak.

About the Author:

Nate Peaty PharmD, MS

As a health-system pharmacy leader, Nate has been responsible for advancing complex, inpatient pharmacy operations and support systems through innovation. His commitment to furthering the role of automation in hospital operations and passion for designing better solutions for healthcare professionals led him to co-found OrbitalRX where, as its Chief Product Officer, he currently is responsible for corporate and product strategy, research, innovation partnerships, and customer relationships. In his role at OrbitalRX, Nate is designing a new generation of pharmacy automation solutions that challenge assumptions and power a more sustainable infrastructure for health-system and  drug supply chains.

Juniper Alcorn, PhD

The Impact of COVID-19 on U.S. Hospital Pharmacies

The Impact of COVID-19 on U.S. Hospital Pharmacies

COVID-19 designThe New England Journal of Medicine reported the first case of the novel coronavirus was confirmed in the United States in January 2020. This means that as of late July, there has been more than six months of sustained uncertainty and instability. We’ve likely all been impacted by COVID-19 in one way or another. Arguably, no one has been more affected than the healthcare workers risking their lives on the front lines every day to care for our loved ones while isolating from their own.

Along with this global pandemic came a wave of fear over the shortage of drugs, be it from supply chain issues or general population hoarding “potential cures” for COVID-19. Over the last 19 years, the American Society of Health-System Pharmacists (ASHP) reports an average of 143 new national drug shortages per year. As of July 20, ASHP is reporting that there is a current shortage of 209 drugs. With the large number of COVID-19 cases, we are battling with shortages of medications that include propofol, fentanyl, and hydroxychloroquine.

To find out how hospital pharmacies are being impacted by COVID-19 so we can share best practices and advice, we reached out to a few of our clients. In this Q&A, we interviewed Meghan, the pharmacy buyer at a large teaching hospital in the Northeast; Kristin, the pharmacy manager at Froedtert Hospital in Milwaukee; and Brian, the Assistant Manager of Pharmacy – Medication Utilization Strategy at University of Virginia Medical Center.

How has your pharmacy team been affected by COVID-19?

Meghan: There have been so many changes to our department affecting so many interdisciplinary teams. A good portion of the team have adjusted their schedules to help out where necessary. There are team members working from home, which is an adjustment. We have staff working in different areas than they are used to. The COVID-19 pandemic has really shown how flexible, talented, and dedicated our department is to our patients.

Kristin: In an effort to remain effective and due to low census, we’ve modified the number of hours staffed and some individuals are now working from home.

Brian: COVID-19 has presented unique challenges. Like many, we’ve learned how to communicate virtually. However, we’ve also seen more shortages of critical drugs at a time when we were already seeing increased usage.

How has COVID-19 affected the state of shortages at your organization?

Meghan: We’ve found the entire drug supply chain to be stressed. We’ve seen some older shortages that we thought were resolving rear their ugly head again (e.g., injectable opioids, IV fluids, heparin). In these instances, we already had plans of action that we could enact. However, COVID-19 has made some of these shortages more severe. We have usage rates that skyrocketed across the system—way over what was previously forecasted. This type of activity creates somewhat of a “perfect storm” where the wholesaler is unable to keep up with our demand, which then carries over to the manufacturer. Fortunately, we started to plan in advance of this pandemic, prioritizing and conserving critical items before we reached the peak.

Kristin: COVID-19 has impacted the quantities available for purchase of products used to treat patients with the virus. Many products have been placed on protective allocations, and we’ve been monitoring these products very closely for on-hand supply. We have also had much more interest in our shortage management process from individuals and disciplines not normally involved.

Brian: There have been more shortages than usual. Some have been more long-term, and many have been temporary. We have also seen challenges in being able to order products since our wholesaler has implemented restrictions to prevent over buying.

How long did it take before you started seeing shortages and what drugs are you seeing major shortages of (example: hydroxychloroquine)?

Meghan: We started seeing shortages almost immediately. We were proactive in adding medications into OrbitalRX so that we would be monitoring them ahead of time and be able to catch trends in our supplies. Some specific medications we’re seeing large declines in are propofol, hydroxychloroquine, cisatracurium, rocuronium, vecuronium, and large volume IV opioids.

Kristin: We started seeing shortages within days of news stories being released and new data emerging. In particular, propofol, Precedex, Nimbex, famotidine, and dexamethasone were the most heavily impacted.

Brian: We began seeing shortages in late February. As the pandemic worsened, many hospitals began purchasing supplies to prepare leading to stress on the supply chain. We have seen significant shortages with metered dose inhalers, opioids, sedation, paralytics and many other critical care drugs. We also saw fluctuating supply of several products that were reported as potential therapeutic options such as hydroxychloroquine, azithromycin, famotidine, and dexamethasone.

How are the shortages impacting non-COVID patients?

Meghan: We’ve implemented restrictions on certain drugs to try to hold that drug supply specific for COVID patients where clinically appropriate. For the most part, we’ve been successful in managing our shortages to the point where there has been little to no impact on non-COVID-19 patients.

Kristin: Fortunately, we’ve been able to maintain supply of all products, so there has been minimal impact for us. We haven’t needed to implement therapeutic interchanges or restrict use to certain populations as of yet.

Brian: Early in the pandemic, many hospitals saw decreases in elective procedures and admissions. Thankfully this allowed us to reserve stock. However, many patients who required critical care were still admitted. For example, we had to work closely with our providers and frontline pharmacy staff to switch between opioids weekly to ensure we had enough of each product when it was most clinically appropriate to use.

Are you experiencing shortages of drugs used to ventilate patients, such as propofol, fentanyl, and morphine?

Meghan: Yes, we saw the biggest hit at the beginning of April, but as of late April/early May, we have a good in-house supply of these items and have a plan in place to move forward in the event these remain in short supply.

Kristin: Yes, these are some of the most impacted products. Many manufacturers have responded by allowing us to purchase directly through them.

Brian: We have seen significant shortages with these agents. Just about any agent used to treat patients with refractory ARDS have been limited. Including those mentioned, we have also seen shortages with paralytics and sedatives such as dexmedetomidine and midazolam.

What adjustments have been made by your team in response to the pandemic?

Meghan: Pharmacy leadership meets multiple times a week as we continue to navigate our way through the health crisis. Our team has been incredibly proactive in preparation. Now that we’re hopefully at the peak, we’re able to project how long our drug supply will last us and determine and predict which items will have the largest impact on our patients. As a pharmacy department, we’re routinely reviewing drug usage and trends in usage so we can quickly pivot when needed.

Kristin: We’ve been closely monitoring specific medications across the system and allocating product to sites as necessary. We’ve also increased buying specific drugs we knew may be used heavily if our COVID-19 volumes increased. We’ve also purchased non-preferred concentrations and vial sizes in order to continue meeting our patients’ needs. Lastly, we’ve increased shift coverage for management of incoming stock and product purchasing.

Brian: We’ve increased our communication and developed strategies for real-time utilization so we can stay on top of any challenges that arise.

What advice can you share with other hospital pharmacies about how to prepare or adjust their strategies?

Meghan: Be flexible. Things will be changing quickly, and teams will need to adjust their plans accordingly. Meet as a team frequently, and discuss all options, changes, and trends you’re seeing. Don’t focus solely on COVID-19 drug supply and usage. Remember to check in on and monitor your pre-COVID-19 drug shortages.

Kristin: Make sure to determine a list of medications that you want to keep a close eye on and create a “goal” for on-hand supply. This gives buyers a clear direction on what to focus on as targets. Be sure to funnel requests for purchasing through one group. This group should be aligned with the team responsible for creating any clinical guidelines and providing direct care to COVID-19 patients. Perform daily monitoring of your supply of critical medications and consider alternate sources outside of your primary wholesaler.

Brian: I recommend keeping an open line of communication with your key stakeholders. Also, pay close attention to the news: you can bet if they report the next “cure” for COVID, it will be short tomorrow and identify a strategy to assess real-time utilization. Lastly, keep track of your changes even if things begin to resolve.

Has OrbitalRX helped your team better manage shortages during this crisis?

Meghan: We’ve been regularly adding records into our OrbitalRx instance and applying COVID-19 labels so we can view all COVID-19-related drugs and their inventory levels at a glance. This was so easy to do. Having notifications is helpful because rather than having to go to the wholesaler and check if a shortage item was back in stock, I can receive a notification that tells me when it’s restocked so I can make a purchase. We’ve been able to better identify trends, such as increasing usage numbers, so we’re able to quickly formulate plans to move forward. OrbitalRx has really made managing shortages so much easier. I’m grateful to have a platform like this during this time to assist in keeping our plans for shortages organized.

Kristin: We’re finding that our process for tracking inventory is much more streamlined. The ability to set a filter for our active shortages that focused on only COVID-19 drugs has been so helpful. Also, the OrbitalRX platform has allowed us to modify our current usage and get a quicker picture of our on-hand supply.

Brian: OrbitalRX was key in keeping track of the many shortages and related inventory. We were able to quickly organize our high use and COVID-19-related shortages by tagging key shortages. At a glance, we were able to see daily inventory for our most critical inventory without having to run multiple reports or getting lost in other shortages. We were also able to give key stakeholder access to our database to allow them to make quick decisions related to ongoing updates.

Thank you to the Workers on the Front Lines
Our team would like to express our utmost respect and gratitude to all of the frontline healthcare workers around the globe. We understand you’re giving 110% to support your patients and community, so we’re giving 110% to building the technology to support your efforts. Contact us if you’d like to schedule a custom demo with our team. We’d love to show you what our platform can do to decrease your workload and increase your efficiency.

About the Author:

Emily Nichols

Emily is the Marketing Director at OrbitalRX. She has been working in marketing in the tech and healthcare sectors for 15 years. The daughter of a medication monitoring and dispensing device inventor, and sister of an Emergency Department RN, the healthcare space was a natural fit for her marketing passion. She has a BS in Communications and Graphic Design.

Juniper Alcorn, PhD